1983, 11-17 Permit: 83B-1809 Plumbing FixturesPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WAS1 INGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1.
LOT
2.
BLOCK
OWNER '
3. 414
MAILING ADDRESS
6 /q ,v Gv
SUBDIVISION
vs
1
PHONE
4.
5.
CON3RACTOR
0 - A.- lift44 �,� •� �•C
PHONE
ZIP
LI N)E - EXPIRES PHONE
3 Ts ✓-35/�s
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North (South
Size of Parcel
East West
Zone Classification
ADgjE ' 3
JJ icntjt ss�`
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
Z7Yd �G
PHONE
ZIP
TO
TYPE .NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF WORK ❑ BLD. .PLMB. ❑ MECH. CIM.H. ❑ POOL ❑OTHER
Type Const.
Occupancy
Residential
Commercial ❑
Spr'nklered
❑Yes CNo Req 'd.
New Const. Valuation
Remode ed Valuation
Main Floor
Upper Floors
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Garage/Storage
Total Bldg. Floor Area
Uncv. Deck
No. Floors
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ No
Received YesNo.
Unfin. Basement
No. Dwellings
Number
DESCRIBE WORK
8.
k 1G1f7vc�f
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
Shorelines/Flood Hazard
Yes Not Applic. C
WATER
PUBLIC ❑
PRIVATE 0
SEWAGE
SEPTIC 0
SEWER 0
Ownership
Public = Private ❑
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the provisi• - • .ny other state or local law regulating construction or the performance
of construction. SEE REVER - SIDE OR - = •UIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATIONS
DATE /T
SPECIAL CONDI ONS: (SEE REVERSE SIDE FOR NOTICE)
O"? C
96'45
S'0OK/
5.,ill C
io
Lid 14
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plans Required ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT NUMBER
1/3 1809
-3* *45,00
*4500
*0.00
18082
11-17-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
' 1 j 7
DATE SS{JED1
PERMIT/10. O' 9 z
*45.0 O 41 -AL